St Johns Medical College

Bangalore, India

St Johns Medical College

Bangalore, India
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Shashidhar A.,St Johns Medical College
Indian pediatrics | Year: 2017

OBJECTIVE: To measure the efficacy of a probiotic formulation on time to reach full enteral feeds in VLBW (very low birth weight) newborns.DESIGN: Blinded randomized control trial.SETTING: A tertiary care neonatal intensive care unit (NICU) in Southern India between August 2012 to November 2013.PARTICIPANTS: 104 newborns with a birth weight of 750-1499 g on enteral feeds.INTERVENTION: Probiotic group (n=52) received a multicomponent probiotic formulation of Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum and Saccharomyces boulardii once a day at a dose of 1.25×109 CFU from the time of initiation of enteral feeds till discharge and the control group (n=52) received only breast milk.OUTCOME MEASURE: Time to reach full enteral feeds (150 mL/kg/day).RESULTS: The mean (SD) time to reach full enteral feeding was 11.2 (8.3) days in probiotic vs. 12.7 (8.9) in no probiotic group; (P=0.4), and was not significantly different between the two study groups. There was a trend towards lower necrotizing enterocolitis in the probiotic group (4% vs. 12%).CONCLUSION: Probiotic supplementation does not seem to result in significant improvement of feed tolerance in VLBW newborns.

Ravikanth R.,St Johns Medical College
Indian Journal of Critical Care Medicine | Year: 2017

Organophosphate poisoning (OP) is a very common mode of suicide in rural and urban areas due to the wide availability of pesticides. The identification of OP and timely referral for appropriate supportive care can be lifesaving. Injury to the central nervous system is a serious entity in acute OP. Application of modern imaging techniques like diffusion weighted imaging increases the diagnostic rate of brain injury in the early period and can provide evidence for medical treatment. We present the imaging features in the intermediate syndrome of OP. © 2017 Indian Journal of Critical Care Medicine Published by Wolters Kluwer - Medknow.

Moodithaya S.,NITTE University | Avadhany S.T.,St Johns Medical College
Journal of Aging Research | Year: 2012

Ageing is associated with changes in cardiac autonomic control as measured by Heart Rate Variability (HRV). Not many studies have explored the influence of gender on age-related changes in cardiac autonomic regulation. This study evaluated the gender differences in age-associated changes in cardiac autonomic nervous activity by assessing HRV using frequency domain analysis of short-term stationary R-R intervals. HRV was studied in healthy males and females ranging in age from 6 to 55 years. Total power and absolute power in High-Frequency (HF) and Low-Frequency (LF) components as well as HF in normalized unit declined significantly with ageing. The HF/LF ratio was significantly higher in the adolescent and adult females compared to male of these age groups. This study suggests that gender differences exist in age-related changes in HRV. The finding that gender differences are limited to adolescent and adult age groups may indicate a role for female sex hormones in cardiac autonomic modulation. © 2012 Shailaja Moodithaya and Sandhya T. Avadhany.

Tirumalae R.,St Johns Medical College
Indian Journal of Dermatology | Year: 2013

Psoriasiform dermatoses often pose challenges to both dermatologists and pathologists alike. With proper clinicopathologic correlation and a systematic approach, it is possible to arrive at a specific diagnosis in most cases. This article attempts to outline a practical, step-wise method of looking at these cases and highlights some important clues in individual conditions.

Ravikumar G.,St Johns Medical College | Ananthamurthy A.,St Johns Medical College
Journal of Cancer Research and Therapeutics | Year: 2014

Purpose: Cyclin D1 is a cell cycle regulatory gene emerging as a potentially significant oncogene in invasive breast cancers. In this study, we attempted to see the expression of Cyclin D1 in invasive ductal carcinomas of the breast in our population and correlate its expression with other known prognostic parameters. Materials and Methods: A total of 39 cases were selected from our case files from January 2011. Immunohistochemistry for Cyclin D1 was performed and interpreted as positive when >10% of the tumor cells expressed the marker with a moderate to strong intensity of staining. Clinicopathological parameters such as laterality, focality, tumor size, grade, ductal carcinoma in situ (DCIS), axillary lymph node (ALN) metastasis, hormone receptor status and human epidermal growth factor receptor 2 status were analyzed and correlated with Cyclin D1 expression. Results: The patients' age ranged from 30 to 76 years (mean = 53.18). The tumors were unilateral and unifocal in 38 cases; one patient had bilateral synchronous tumors. The majority were grade2 (67.5%) and tumor size T2 (57.5%). Nearly 35% were associated with DCIS and 57.5% had ALN metastasis. Estrogen receptors (ER) and progesterone receptor (PgR) positivity was seen in 65% of the cases and 25% was triple negative. Cyclin D1 expression was seen in 67.5% of the cases in our study. Among the ER, PgR positive and Her-2 negative tumors, Cyclin D1 expression was seen in the majority of cases (92%) cases, whereas none of the triple negative tumors showed Cyclin D1 expression. The other prognostic parameters such as tumor size, grade and lymph node status did not show any association with Cyclin D 1 positivity. Conclusions: Cyclin D1 expression was seen in 67.5% of ductal carcinoma and it showed a significant correlation with ER, PgR expression (92% in this study), which is in concordance with other similar studies in literature.

Deepthi R.,Sri Devaraj Academy of Higher Education and Research | Kasthuri A.,St Johns Medical College
Archives of Gerontology and Geriatrics | Year: 2012

Hearing loss is a potentially disabling problem among elderly leading to physical and social dysfunction. Though audiometric assessment of hearing loss is considered as gold standard, it is not feasible in community settings. Several questionnaires measuring hearing handicap have been developed. Knowledge regarding applicability of these questionnaires among rural elderly is limited, hence a study was planned to validate single question and Shortened Hearing Handicap Inventory for Elderly (HHIE-S) in detecting hearing loss against pure tone-audiometry among rural Indian elderly. A single question 'do you feel you have a hearing loss?' and the HHIE-S was administered to 175 elderly in two rural areas. Hearing ability was assessed using pure tone audiometry. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of both screening tools were compared with pure tone averages (PTAs) greater than 25, 40 and 55. dB hearing level (mild, moderate and severe hearing loss, respectively). The single question yielded low sensitivity (30.9%) and high specificity (93.9%) for mild hearing loss. Similarly HHIE-S yielded a sensitivity of 26.2% and specificity of 95.9%. Sensitivity with single question increased to 76.2% and specificity decreased to 83.1% with severe hearing loss. Sensitivity with HHIE-S also increased to 76.2% and specificity decreased to 87.7% with severe hearing loss. These hearing screening questionnaires will be useful in identifying more disabling hearing losses among rural elderly which helps in rehabilitation services planning. © 2012 Elsevier Ireland Ltd.

Diener H.-C.,University of Duisburg - Essen | Connolly S.J.,Hamilton Health Sciences | Ezekowitz M.D.,Lankenau Institute for Medical Research and the Heart Center | Wallentin L.,Uppsala University | And 5 more authors.
The Lancet Neurology | Year: 2010

Background: In the Randomised Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial, dabigatran reduced occurrence of both stroke and haemorrhage compared with warfarin in patients who had atrial fibrillation and were at increased risk of stroke. We aimed to assess the effects of dabigatran compared with warfarin in the subgroup of patients with previous stroke or transient ischaemic attack. Methods: In the RE-LY trial, 18 113 patients from 967 centres in 44 countries were randomly assigned to 110 mg or 150 mg dabigatran twice daily or to warfarin dose adjusted to international normalised ratio 2·0 to 3·0. Median follow-up was 2·0 years (IQR 1·14-2·86), and the primary outcome was stroke or systemic embolism. The primary safety outcome was major haemorrhage. Patients and investigators were aware of whether patients received warfarin or dabigatran, but not of dabigatran dose, and event adjudicators were masked to treatment. In a predefined analysis, we investigated the outcomes of the RE-LY trial in subgroups of patients with or without previous stroke or transient ischaemic attack. RE-LY is registered with, NCT00262600. Findings: Within the subgroup of patients with previous stroke or transient ischaemic attack, 1195 patients were from the 110 mg dabigatran group, 1233 from the 150 mg dabigatran group, and 1195 from the warfarin group. Stroke or systemic embolism occurred in 65 patients (2·78% per year) on warfarin compared with 55 (2·32% per year) on 110 mg dabigatran (relative risk 0·84, 95% CI 0·58-1·20) and 51 (2·07% per year) on 150 mg dabigatran (0·75, 0·52-1·08). The rate of major bleeding was significantly lower in patients on 110 mg dabigatran (RR 0·66, 95% CI 0·48-0·90) and similar in those on 150 mg dabigatran (RR 1·01; 95% CI 0·77-1·34) compared with those on warfarin. The effects of both doses of dabigatran compared with warfarin were not significantly different between patients with previous stroke or transient ischaemic attack and those without for any of the outcomes from RE-LY apart from vascular death (110 mg group compared with warfarin group, interaction p=0·038). Interpretation: In patients with previous stroke or transient ischaemic attack, the effects of 110 mg dabigatran and 150 mg dabigatran on stroke or systemic embolism were similar to those of warfarin. Most effects of both dabigatran doses were consistent in patients with versus those without previous stroke or transient ischaemic attack. Funding: Boehringer Ingelheim. © 2010 Elsevier Ltd.

Gupta S.,St Johns Medical College
Indian journal of medical sciences | Year: 2010

Shigellosis is a disease of public health importance in developing countries. It may cause self-limited diarrhea to severe dysentery. Emergence of multi drug resistant (MDR) strains is a growing concern globally. Ceftriaxone and ciprofloxacin are the drugs of choice for MDR cases. Here, we report a case of MDR Shigella flexneri from an immunocompromised patient. The strain was resistant to ceftriaxone [minimum inhibitory concentration (MIC) ≥ 64 μg/ml], limiting the treatment option. Simultaneously, the strain was also found to be resistant to ciprofloxacin (MIC ≥ 4 μg/ml). However, it was susceptible to ceftazidime (MIC 4 μg/ml). This is the first case of ceftriaxone resistant Shigella spp. reported from our hospital.

Nandeesh B.N.,St Johns Medical College | Rajalakshmi T.,St Johns Medical College
American Journal of Dermatopathology | Year: 2012

Background:: Hidradenomas are rare benign adnexal neoplasms that encompass a morphological gamut with a range of differentiation. As a consequence, there is a great likelihood of being mistaken for other primary and metastatic tumors. Though conventionally regarded as eccrine, they have been reclassified into eccrine and apocrine types. Objective:: This study aims to document the histological spectrum of nodular hidradenomas, with particular reference to categorizing them into eccrine or apocrine tumors. Results:: A total of 15 cases with features of nodular hidradenoma with their age ranging from 18 years to 73 years were studied. Most of the cases were solitary, circumscribed, solid and cystic, dermal, symmetrical, lobulated tumors with a sheet-like and papillary architecture. The cells were chiefly eosinophilic with a regular oval grooved nucleus and a small inconspicuous nucleolus. Clear cells were also seen. Squamous differentiation was an important feature, with most showing a infundibular type of keratinization. Sebaceous differentiation is also common. The stroma varied from hyaline to myxoid. Only 1 case showed poroid differentiation. Conclusions:: This study describes the assortment of histologic characteristics in hidradenomas. Apocrine hidradenomas are more common, contrary to earlier belief that favored an eccrine origin. © 2012 by Lippincott Williams & Wilkins.

Pais P.,St Johns Medical College
National Medical Journal of India | Year: 2013

Acute coronary syndromes (ACS) are the commonest acute manifestation of coronary artery disease and a major cause of hospitalization and death. Plaque rupture and subsequent platelet activation are the key factors in its pathogenesis. Platelet inhibitors are crucial in the management of ACS. Aspirin remains the standard antiplatelet but use of dual antiplatelet drugs is beneficial in ACS. Platelet P2Y12 receptor inhibitors are an important group of antiplatelet compounds that can be combined with aspirin in the management of ACS. P2Y12 inhibitors may belong to the thienopyridine or nonthienopyridine group of compounds. The former (clopidogrel, prasugrel) combine irreversibly with the receptor and therefore have a prolonged duration of action. On the other hand, the non-thienopyridine compounds (ticagrelor, elinogrel) have a reversible action and hence a shorter duration of action. Several new compounds in this group have become or are likely to become available. The newer agents have a more uniform and complete antiplatelet effect and are much less likely to be affected by genetic variability of CYP2C19 enzyme activity compared with that of clopidogrel. Large phase 3 trials have shown that ticagrelor and prasugrel reduce major cardiovascular events in ACS compared to clopidogrel when given in addition to aspirin. This is accompanied by some increase in bleeding. © The National Medical Journal of India 2013.

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